Self-Reported Everyday Functioning After COVID-19 Infection

Key Points Question Do veterans who had a history of COVID-19 report worse everyday function 18 months after their infection than veterans with a similar risk with no history of COVID-19? Findings In this cohort study of 372 veterans, many veterans reported worse everyday function compared with how they recalled feeling before the COVID-19 pandemic. However, there was no consistent pattern of worse functioning among those who had a confirmed infection of COVID-19 compared with those without confirmed infection. Meaning These findings suggest that the negative impacts of the COVID-19 pandemic on everyday function may occur via multiple pathways regardless of whether or not they had a documented infection with COVID-19.


eTable 1: Variables included in propensity score
Construction of all variables and matches have been previously described at https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-023-01882-zCategorical variables included in propensity score: • immunosuppressive medication use  -14.27 -31.30, 2.77 -4.00 -14.60, 6.59 eTable 9. Association of Survey Participation with Post-COVID VA Healthcare Utilization, Among those with Documented COVID-19.Unweighted regression.We sought to assess the extent to which survey respondents were systematically different than non-respondents in their experience of COVID-19.Differences in pre-COVID-19 characteristics, we reasoned, would be rebalanced based on our non-response and other survey weights.So we examined observed differences in health care utilization among survey respondents who had documented COVID-19 (and consented to linkage to their medical records, n=164), compared to those Veterans eligible for the survey but who were not successfully contacted or did not offer consent to the survey (n=341).We used the month-by-month data on utilization constructed as part of the inverse probability of censoring weights for a related project in this cohort and for which methods have been published (PMID: 37603339).
We examined 5 measures: inpatient admissions (dichotomous); and number of primary care interactions (continuous); mental health interactions (continuous); and of specialty care interactions.We attempted to examine community-living center admission (dichotomous), but it was too rare in this cohort to estimate.We adjusted in these analyses for all the same variables included in the LASSO regression in this paper to build the non-response and survey weights.There were no significant differences in rates of admission, specialty care interactions, or mental health interactions, but survey responders did have modestly more primary care interactions.We interpret this cautiously as suggesting broadly similar health experiences between respondents and non-respondents, but with somewhat greater comfort among survey respondents in interacting with the VA healthcare system. Among

eTable 2: Descriptive Statistics and Standardized Mean Differences for COVID-19 Cases and Their Matched Comparators
Indicators for diagnosed CDC high-risk conditions based on ICD-19 codes: coronary heart disease, cancer (excluding non-metastatic skin cancers), chronic kidney disease, congestive heart failure, pulmonary-associated conditions (including asthma, COPD, interstitial lung disease, and cystic fibrosis), dementia, diabetes, hypertension, liver disease, sickle cell/thalassemia, solid organ or blood stem cell transplant, stroke/cerebrovascular disorders, substance use disorder, anxiety disorder, bipolar disorder, major depression, PTSD, and schizophrenia • Vaccination status (January-April 2021) • Gagne comorbidity score • distance from a Veteran's home to nearest VA hospital • count of CDC high-risk conditions • count of mental health conditions • four VA utilization measures (inpatient admissions, primary care visits, specialty care visits, mental health visits in the prior 2 years).(unweighted)

eTable 3. Association of COVID-19 with Thresholds of Morbidity at 18 months.
Unweighted within-pair conditional logistic regression, adjusted for race and ethnicity.Confidence intervals including 1 indicate no statistically significant association; odds ratios greater than 1 indicate more common after COVID-19 than in matched comparators.I/ADL: activities and instrumental activities of daily living.

Association of COVID-19 with Continuous Measures of Morbidity at 18 months.
Unweighted paired regression, adjusted for race and ethnicity.Coefficients represent the absolute increase (decrease if negative) in the average scores of COVID-19 infected patients compared to their specific matched comparator.Confidence intervals including 0 indicate no statistically significant association; positive coefficients indicate more common after COVID-19 than in matched comparators.I/ADL: activities and instrumental activities of daily living.

Association of COVID-19 with Thresholds of Morbidity at 18 months.
Weighted within-pair conditional logistic regression, adjusted for race and ethnicity, including 8 pairs where the comparator was later found to have COVID-19.Confidence intervals including 1 indicate no statistically significant association; odds ratios greater than 1 indicate more common after COVID-19 than in matched comparators.I/ADL: activities and instrumental activities of daily living.

Association of COVID-19 with Continuous Measures of Morbidity at 18 months.
Weighted paired regression, adjusted for race and ethnicity, including 8 pairs where the comparator was later found to have COVID-19.Coefficients represent the absolute increase (decrease if negative) in the average scores of COVID-19 infected patients compared to their specific matched comparator.Confidence intervals including 0 indicate no statistically significant association; positive coefficients indicate more common after COVID-19 than in matched comparators.I/ADL: activities and instrumental activities of daily living.

Association of COVID-19 with Thresholds of Morbidity at 18 months (Analyzed Separately by Whether Initial COVID-19 Case was Hospitalized or Not).
Weighted within-pair conditional logistic regression, adjusted for race and ethnicity.Confidence intervals including 1 indicate no statistically significant association; odds ratios greater than 1 indicate more common after COVID-19 than in matched comparators.32 COVID-19 patients were hospitalized within 7-days of their initial positive test in VA.Note that these should be considered hypothesis generating in a target trial emulation framework, as whether or not COVID-19 leads to an acute hospitalization may be part of the causal pathway by which COVID-19 causes adverse mortality.In the language of clinical trials that target trial emulation seeks to follow, hospitalization is a "post-randomization" variable.I/ADL: activities and instrumental activities of daily living.

Association of COVID-19 with Continuous Measures of Morbidity at 18 months (Analyzed Separately by Whether Initial COVID-19 Case was Hospitalized or Not).
Weighted paired regression, adjusted for race and ethnicity.Coefficients represent the absolute increase (decrease if negative) in the average scores of COVID-19 infected patients compared to their specific matched comparator.Confidence intervals including 0 indicate no statistically significant association; positive coefficients indicate more common after COVID-19 than in matched comparators.32 COVID-19 patients were hospitalized within 7-days of their initial positive test in VA.Note that these should be considered hypothesis generating in a target trial emulation framework, as whether or not COVID-19 leads to an acute hospitalization may be part of the causal pathway by which COVID-19 causes adverse mortality.In the language of clinical trials that target trial emulation seeks to follow, hospitalization is a "post-randomization" variable.I/ADL: activities and instrumental activities of daily living.